To Floss or Not to Floss

By Catherine M. Fascilla, D.D.S.

In a letter to the Associated Press, the government acknowledged that the effectiveness of flossing had never been researched as required. When the Associated Press (AP) announced in August 2016 that there is little proof that flossing works, my patients were shocked. In the past twenty-five years of practice, very few news events have elicited as much of a visceral reaction as the shocking announcement that flossing may not be necessary! Naturally my patients wanted to know what I thought. Before I get to that, let me give you a little background information.

Flossing daily to prevent gum disease and cavities is one of the most universal recommendations for public health. The federal government first made this recommendation in the surgeon general’s report in 1979 and later in its Dietary Guidelines for Americans published every five years.

A dentist, Levi Spear Parmly, invented floss in the early 19th century. By the time it was patented in 1874, dentists were widely recommending its use. At that time, no proof of efficacy was required. By 1908, the American Dental Association started promoting it based on what dentists were doing in their clinical practices. The American Academy of Periodontology and the manufacturers of floss have been encouraging the practice for decades.

Last year the AP under the Freedom of Information Act, crequested that the Department of Health and Human Services provide evidence for its guidelines. By law, the guidelines must be based on strict scientific studies. However, in its latest set of guidelines issued this year, the federal government omitted the recommendation to floss admitting to the AP that adequate research to support this recommendation did not exist.

Many of the current studies proving the benefits of flossing are considered biased because they are funded by manufacturers of floss. Other studies are said to be unreliable, using outdated methods, testing too few people and not testing over a long enough period of time.

What do I think? I so strongly believe in the benefits of flossing that I have included it as the final step of every hygiene visit for every patient that has ever had a cleaning in my office and I will continue to do so regardless of the lack of “scientific evidence”. I know how great I personally feel when I floss regularly and I notice the difference if I miss a few days. I have noticed it with all of my patients. Those who floss regularly generally have the healthiest gums, the least number of cavities, and substantially less bleeding during treatment.

We know that the bacteria in plaque causes gum disease and tooth decay. It is indisputable that plaque removal is absolutely necessary for healthy teeth and gums and for fresh breath. To date, the most effective method of plaque removal is still mechanical debridement with a toothbrush. While effective for most of the plaque, a brush can not reach the contact areas between teeth. Those areas are only accessible by flossing or with a Waterpik (a device that uses water pressure and pulsation to remove food and break up plaque).

Interestingly enough, the consensus among the patients who have brought up the subject, whether they floss regularly or not, is that it is beneficial to do so. They too notice the difference.

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